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Improved acute lymphoblastic leukemia treatment offers hope for eliminating irradiation

Improved risk classification for patients with acute lymphoblastic leukemia (ALL), coupled with more intensive intrathecal chemotherapy for high risk patients and the use of a drug called dexamethasone, could one day permit physicians to omit irradiation as a part of routine treatment. These findings emerged from a clinical trial conducted by investigators at St. Jude Children's Research Hospital. For intrathecal chemotherapy the drugs are injected into the cerebrospinal fluid-filled spaces between the thin membranes covering the spinal cord.

The researchers base their conclusion on results of a study of ALL treatment at St. Jude called Total Therapy Study XIIIB, which are reported in the Nov. 1 issue of the journal Blood. The overall five-year event-free survival rate of the children in Study XIIIB was just above 80 percent, and the overall survival rate was about 86 percent, according to the researchers. Event-free survival means that patients do not experience a recurrence of symptoms or other complications related to the disease or its treatment.

The researchers substituted dexamethasone for the routinely used drug prednisone to achieve greater antileukemic effects in both the central nervous system (brain and spinal cord) and the blood stream. The investigators also used more precise criteria to identify those children who should get more intensive intrathecal and intravenous therapy because they were at high risk for treatment failure.

Success of the modified chemotherapy treatment of XIIIB is significant because it established the importance of intensifying intrathecal chemotherapy early in treatment, and also set the stage for the current St. Jude clinical trial that omits the use of cranial irradiation in all patients, according to Ching-Hon Pui, M.D., director of the St. Jude Leukemia/Lymphoma Division, and American Cancer Society F.M. Kirby Clinical Research Professor. Pui is the first author of the Blood article.

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Contact: Bonnie Cameron
bonnie.cameron@stjude.org
901-495-4815
St. Jude Children's Research Hospital
1-Nov-2004


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